How to make a complaint about the DVLA medical assessment process

HRO - Applied for Licence - Medical Process

Convicted Driver Insurance

Luna2000

Established Member
Due to get my licence back on the 10th December and have sent off the application with a completed DR1 medical questionnaire and approval to contact my GP. Told them I take asthma medication (shouldn't be a problem) and also codeine phosphate for back pain (3 x 60mg per day.) I have also not spoken to my GP re any alcohol related issues since November 2017. Received a letter from DVLA saying they had written to my GP to ensure that they (my GP) do not have any concerns that my medical condition affects my ability to safely control my vehicle at all times. Surprisingly, they haven't made any mention of going for a CDT test with another GP which is what I thought the first step would be. Can anyone else comment as to whether this is the standard route or whether the CDT test usually takes place first? The implication is that they will wait until they hear back from my GP before deciding on what to do next i..e send me for the test.
 
Luna2000 said:
Due to get my licence back on the 10th December and have sent off the application with a completed DR1 medical questionnaire and approval to contact my GP. Told them I take asthma medication (shouldn't be a problem) and also codeine phosphate for back pain (3 x 60mg per day.) I have also not spoken to my GP re any alcohol related issues since November 2017. Received a letter from DVLA saying they had written to my GP to ensure that they (my GP) do not have any concerns that my medical condition affects my ability to safely control my vehicle at all times. Surprisingly, they haven't made any mention of going for a CDT test with another GP which is what I thought the first step would be. Can anyone else comment as to whether this is the standard route or whether the CDT test usually takes place first? The implication is that they will wait until they hear back from my GP before deciding on what to do next i..e send me for the test.
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Are you a HRO ?(High Rick Offender). If yes, then you should undergo a Medical (CDT test and other physical exams). If not it should be straight
forward without a CDT test.
 
DVLA normally get the DR1 with the medical result. As you have sent it off with the application, they want to see the extent of your issues you saw the doctor about before they splash money on a CDT test. If they feel you have been alcohol dependent then they could refuse the issue of a licence without bothering with the CDT at this time.
 
Thanks. I will make an appointment with the Doctor they have sent the application to and discuss with him. I haven't been diagnosed as alcoholic but did 'misuse' it as a means of pain and stress control for about 5 years. Last spoke to doctor regarding it in November 2017 and haven't drank for a while. Did get some NHS counselling, but hopefully that will be seen as pro-active and not a negative. Never had any medication in order to stop drinking and didn't have any withdrawal symptoms when I came off it.
 
They will be asking your GP, as part of a long questionnaire about various conditions, whether you misused alcohol, it if you were dependent on it.

If they see it as misuse they require six months of controlled drinking or abstinence to get your licence back.

If they see it as dependence - and that seems not unlikely if you were speaking to your doctor about it for five years - then they require a years total abstinence to give you your licence back.

These are what the DVLA refers to as red flags, e.g. there is no discretion. Because of that I would make an appointment with your GP urgently to discuss it, if they put you are dependent on alcohol you would almost certainly not get your licence.

They are writing to your GP first because you have said you are on long term codeine. You aren't allowed to have opiate medication in your system when driving unless the doctor tells you you can drive, and you aren't impaired by it. If the doctor hasnt said you can drive, then again you won't get your licence back. 180mg a day is a high dose and again you should confirm with your GP both that you can drive, and that your driving won't be impaired, and make sure it is recorded on your notes.
 
TipsyNurse said:
They will be asking your GP, as part of a long questionnaire about various conditions, whether you misused alcohol, it if you were dependent on it.

If they see it as misuse they require six months of controlled drinking or abstinence to get your licence back.

If they see it as dependence - and that seems not unlikely if you were speaking to your doctor about it for five years - then they require a years total abstinence to give you your licence back.

These are what the DVLA refers to as red flags, e.g. there is no discretion. Because of that I would make an appointment with your GP urgently to discuss it, if they put you are dependent on alcohol you would almost certainly not get your licence.

They are writing to your GP first because you have said you are on long term codeine. You aren't allowed to have opiate medication in your system when driving unless the doctor tells you you can drive, and you aren't impaired by it. If the doctor hasnt said you can drive, then again you won't get your licence back. 180mg a day is a high dose and again you should confirm with your GP both that you can drive, and that your driving won't be impaired, and make sure it is recorded on your notes.
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Hi Tipsy Nurse

Thanks for the reply. I have discussed this before with my GP and he has said that I am not dependent on it (which I don't think I am as I don't need it to function every day,) but that I have probably misused it in the past to deal with work related stress and back pain made worse by the said stress. As I have now retired, the work related stress is no longer a factor. My GP has never said I cannot/should not drive and although 180mg may seem a high dose, I have been taking codeine for a number of years due the back pain (also tried Pregabalin with no success,) so I have built up some resistance to it. I also usually take it at night before bed and take it only after driving not before. I'm will be calling him tomorrow to make an appointment to discuss the issue. I know people on Morphine tablets that are still able to drive, so hopefully the Codeine won't be seen as an issue as the drinking has stopped.
 
The medical definition of dependence is slightly more nuanced then whether you need it to function every day. Officially the NHS uses a classification called ICXD but in practice most use DSM as it is more user friendly.

That says that to be classed as alcohol dependent you need to have three or more of the following symptoms over the past twelve months: -
  1. Tolerance
  2. Withdrawal symptoms or clinically defined alcohol withdrawal syndrome
  3. Use in larger amounts or for longer periods than intended
  4. Persistent desire or unsuccessful efforts to cut down on alcohol use
  5. Time is spent obtaining alcohol or recovering from effects
  6. Social, occupational and recreational pursuits are given up or reduced because of alcohol use
  7. Use is continued despite knowledge of alcohol-related harm (physical or psychological)
You can see that, depending on how you interpret it, many people who would view themselves as moderate drinkers would be classed as dependent officially.

Likewise as you know long term codeine usage is strongly discouraged amongst prescribers nowadays.

For that reason you want to be sure that the most recent record on your health file is one saying you aren't clinically dependent, and that your driving won't be impaired by codeine, so that there can be no doubt when the GP fills in the questionnaire.

Better safe than sorry.
 
TipsyNurse said:
The medical definition of dependence is slightly more nuanced then whether you need it to function every day. Officially the NHS uses a classification called ICXD but in practice most use DSM as it is more user friendly.

That says that to be classed as alcohol dependent you need to have three or more of the following symptoms over the past twelve months: -
  1. Tolerance
  2. Withdrawal symptoms or clinically defined alcohol withdrawal syndrome
  3. Use in larger amounts or for longer periods than intended
  4. Persistent desire or unsuccessful efforts to cut down on alcohol use
  5. Time is spent obtaining alcohol or recovering from effects
  6. Social, occupational and recreational pursuits are given up or reduced because of alcohol use
  7. Use is continued despite knowledge of alcohol-related harm (physical or psychological)
You can see that, depending on how you interpret it, many people who would view themselves as moderate drinkers would be classed as dependent officially.

Likewise as you know long term codeine usage is strongly discouraged amongst prescribers nowadays.

For that reason you want to be sure that the most recent record on your health file is one saying you aren't clinically dependent, and that your driving won't be impaired by codeine, so that there can be no doubt when the GP fills in the questionnaire.

Better safe than sorry.
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Hi TipsyNurse

Interesting list re what defines alcohol dependency.

1 - I think that everyone who drinks develops tolerance to some extent. When you start consuming alcohol as a teenager you will feel fairly'merry' after just a few pints. Over a number of years and drinking as most of us did as young adults 3/4 nights at the end of the week/weekends, your tolerance level increases so it takes more to get that 'merry ' feeling. That's just a physiological fact.
2. I have never had withdrawal symptoms or been hospitalised or diagnosed with withdrawal syndrome.
3. Yes, I have 'abused' it in the past, initially as a form of work related stress relief which is the main reason I went to my GP in the first place.
4. Not over the last year.
5. Not over the last year - but this applies to 'heavy' social drinkers e.g. Monday morning absence syndrome which I never had.
6. Not over the last year - and as 5 above.
7. Not over the last year.

I can honestly say that until I retired I had never missed a single day at work related to alcohol consumption.

Regarding the codeine use. I have upper spinal scoliosis with some deterioration between between C4 & C5 plus a 30 year old lower back injury caused by playing squash that causes sciatica but which has not responded to Sacro Injections, Physio, Acupuncture etc. The pain is chronic but not acute. I.E. it is there all the time like a nagging toothache. Short of moving onto Hydrocodone or Morphine, these are the strongest painkillers I am willing to take. I cannot take Ibuprufen due to Asthma, so am at a loss as to where to go next with the medication (and yes, I have been to a Pain Specialist.) The daily codeine dosage is actually less than if I were taking 8 x 500/30mg Co-Codomol per day.

As the last time I went to my GP re alcohol was a year ago, then I don't know how he or anyone else could say I have any of the above symptoms in relation to alcohol.

Anyway, I have been trying to contact him all morning without success but will try again this afternoon and either discuss with him on the phone or make an appointment. It will be interesting to see what the DVLA has asked him in their letter as they have said to me "I hope you appreciate that we need to write to your doctor/consultant to ensure that they do not have any concerns that your medical condition affects your ability to safely control your vehicle at all times."

As I have not been diagnosed as 'alcohol dependent,' then the only medical conditions I have are Asthma, HBP (controlled,) and Back Pain.

As I said previously, I know numerous people who are still driving after being prescribed Morphine for various conditions.

I'll update you after I speak with him.

PS - Like your 'handle.' I hope it means you were tipsy in the past (LOL)
 
Tipsy sometimes but not when on duty ;)

I agree with you that both sound reasonable, but there are threads on here where the doctor has incorrectly said that there is an issue. Quite apart from delaying the return of your licence the DVLA are the most unreasonable people in the world and correcting any mistakes tends to be about as much fun as Chlamydia.

If they record on your record that neither is a problem you have covered all bases.
 
TipsyNurse said:
Tipsy sometimes but not when on duty ;)

I agree with you that both sound reasonable, but there are threads on here where the doctor has incorrectly said that there is an issue. Quite apart from delaying the return of your licence the DVLA are the most unreasonable people in the world and correcting any mistakes tends to be about as much fun as Chlamydia.

If they record on your record that neither is a problem you have covered all bases.
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Hi TipsyNurse

Just found out the Doctor I wanted to see is on holiday for 3 weeks. The GP practice is set up so that you don't always see the same Doctor but I wanted this one to reply as he was the one who told me I didn't have a problem. I now have to drop them a letter asking to speak to whichever Dr the letter has been referred to. Can't wait.
 
Normally they will just wait until the GP gets back not least because they get paid for completing it and GPs, like the rest of us, are always up for some easy money.

You could probably and check it will be put on hold for them, unless you want it completed quicker to speed the process.
 
TipsyNurse said:
Normally they will just wait until the GP gets back not least because they get paid for completing it and GPs, like the rest of us, are always up for some easy money.

You could probably and check it will be put on hold for them, unless you want it completed quicker to speed the process.
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I'm still surprised that they have opted to pay for a GP report before the CDT Medical which I will pay for. If I fail the CDT medical then it would save them money on a GP report.
 
Luna2000 said:
Due to get my licence back on the 10th December and have sent off the application with a completed DR1 medical questionnaire and approval to contact my GP. Told them I take asthma medication (shouldn't be a problem) and also codeine phosphate for back pain (3 x 60mg per day.) I have also not spoken to my GP re any alcohol related issues since November 2017. Received a letter from DVLA saying they had written to my GP to ensure that they (my GP) do not have any concerns that my medical condition affects my ability to safely control my vehicle at all times. Surprisingly, they haven't made any mention of going for a CDT test with another GP which is what I thought the first step would be. Can anyone else comment as to whether this is the standard route or whether the CDT test usually takes place first? The implication is that they will wait until they hear back from my GP before deciding on what to do next i..e send me for the test.
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They did the same with me, because I had mentioned other illness, they ask the DR to complete M2 questionnaire asking about your fitness to drive, alcohol & drug misuse, dependency last hospital admittance, if this goes back to them saying GP feels you are fit to drive they will write to you with the details of the where to go for CDT test
 
JayJay46 said:
They did the same with me, because I had mentioned other illness, they ask the DR to complete M2 questionnaire asking about your fitness to drive, alcohol & drug misuse, dependency last hospital admittance, if this goes back to them saying GP feels you are fit to drive they will write to you with the details of the where to go for CDT test
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That's what you get for being honest I suppose. Although I would imagine that they would write to your GP in any case given the HRO status. If you don't mind me asking JayJay46, have you managed to stop or cut down on your alcohol consumption? My problem crept up on me so suddenly that it came as a shock as up util the age of 56, I was a 4 cans of lager a week drinker.
 
Luna2000 said:
That's what you get for being honest I suppose. Although I would imagine that they would write to your GP in any case given the HRO status. If you don't mind me asking JayJay46, have you managed to stop or cut down on your alcohol consumption? My problem crept up on me so suddenly that it came as a shock as up util the age of 56, I was a 4 cans of lager a week drinker.
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I used alcohol for many years as a coping mechanism, only misuse not dependence, I didn't need it to function. I took my last drink last New years eve, I decided that the new year would be a new start, I quite drinking, quite smoking and joined slimming world and haven't looked back so in approx. 7 weeks I would have been Teetotal for 1 year. I have my medical this coming Monday. My GP seems to think I will be fine, all my liver function test show normal liver ranges, my scan shows no liver damage although slightly fatty, and although ive not had a drink in nearly 12 months my GGT level is raised last result October 170, six months previous 260, so it is coming down steadily, my GP is of the opinion this is because of the fatty liver and this takes time to rectify its self, but having read a lot of negatives on here about CDT readings being high when people say they haven't drank for 3+ months does have me worried, but it will be what it will be, but I know ive done all the right things, quit drinking quit smoking changed my diet and am taking thiamine & multi vitamins
 
JayJay46 said:
I used alcohol for many years as a coping mechanism, only misuse not dependence, I didn't need it to function. I took my last drink last New years eve, I decided that the new year would be a new start, I quite drinking, quite smoking and joined slimming world and haven't looked back so in approx. 7 weeks I would have been Teetotal for 1 year. I have my medical this coming Monday. My GP seems to think I will be fine, all my liver function test show normal liver ranges, my scan shows no liver damage although slightly fatty, and although ive not had a drink in nearly 12 months my GGT level is raised last result October 170, six months previous 260, so it is coming down steadily, my GP is of the opinion this is because of the fatty liver and this takes time to rectify its self, but having read a lot of negatives on here about CDT readings being high when people say they haven't drank for 3+ months does have me worried, but it will be what it will be, but I know ive done all the right things, quit drinking quit smoking changed my diet and am taking thiamine & multi vitamins
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HI JayJay46

You story sounds a bit similar to my own. When I drank it did the opposite of making me function as it simply sent me to sleep. I have never been sent down the liver test route although my GP did take my GGT levels a few years ago as part of an 'MOT.' He never asked me to come back for any consultation so I suppose they were within the bounds of acceptability. I dropped a letter into my GP last Thursday asking them to contact me prior to writing to the DVLA, so I'll just need to wait until they do or chase them up with a call next week. Hope your medical and CDT go okay on Monday and be sure to let me know how things go.
 
I think it would be highly unusual for your GP to wait for your permission before sending back the DVLA questionnaire. Doctors and nurses tend to have an absolute obsession equally with signing things, and gossiping about people who have lost their job and been hunted down by an NHS appointed chainsaw murderer because they signed something inaccurate.

I think if you are thought to be interfering with the questionnaire that would be seen as unwelcome, which is why it is best to make an appointment before the questionnaire arrives.

Apologies if I have misunderstood what you meant.
 
TipsyNurse said:
I think it would be highly unusual for your GP to wait for your permission before sending back the DVLA questionnaire. Doctors and nurses tend to have an absolute obsession equally with signing things, and gossiping about people who have lost their job and been hunted down by an NHS appointed chainsaw murderer because they signed something inaccurate.

I think if you are thought to be interfering with the questionnaire that would be seen as unwelcome, which is why it is best to make an appointment before the questionnaire arrives.

Apologies if I have misunderstood what you meant.
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Hi There

Thanks for your input again. I don't yet know if the GP has received the questionnaire but I don't think that a discussion with whichever GP completes it would in any way sway them in their reply. I have a fairly good relationship with my GP's having been attending them for years with Asthma, associated chest infections and back pain. The alcohol issues are fairly recent culminating obviously in the ban. I really just want to ensure that they have not said I am 'dependent' on my files. As I haven't been hospitalised, had treatment for blackouts or had medication to stop me drinking alcohol, I don't think/hope they have, but you never know.
 
Luna2000 said:
HI JayJay46

You story sounds a bit similar to my own. When I drank it did the opposite of making me function as it simply sent me to sleep. I have never been sent down the liver test route although my GP did take my GGT levels a few years ago as part of an 'MOT.' He never asked me to come back for any consultation so I suppose they were within the bounds of acceptability. I dropped a letter into my GP last Thursday asking them to contact me prior to writing to the DVLA, so I'll just need to wait until they do or chase them up with a call next week. Hope your medical and CDT go okay on Monday and be sure to let me know how things go.
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It will depend on what your GP is like as to whether they contact you prior to completing the forms for DVLA as it is supposed to be confidential and answered solely using your medical records, I was lucky I have a nice GP who after making the error on my form telephoned me to discuss the rectification letter and said that if they write to her again she will discuss it with me before sending it back.
 
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